期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
卷 127, 期 3, 页码 654-660出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2010.12.1111
关键词
Peanut allergy; oral immunotherapy; desensitization; food allergy
资金
- Food Allergy & Anaphylaxis Network
- Food Allergy Initiative
- Gerber Foundation
- National Institutes of Health (NIH) [1 R01-AI06874-01A1, T32]
- National Center for Research Resources, a component of the NIH [1 UL1 RR024128-01]
- NIH Roadmap for Medical Research
- National Peanut Board
- NIH NIAID
- DYAX Corp
- Thrasher Research Fund
- American Lung Association
- Cephalon
- Wallace Research Foundation
Background: Open-label oral immunotherapy (OIT) protocols have been used to treat small numbers of patients with peanut allergy. Peanut OIT has not been evaluated in double-blind, placebo-controlled trials. Objective: To investigate the safety and effectiveness of OIT for peanut allergy in a double-blind, placebo-controlled study. Methods: In this multicenter study, children ages 1 to 16 years with peanut allergy received OIT with peanut flour or placebo. Initial escalation, build-up, and maintenance phases were followed by an oral food challenge (OFC) at approximately 1 year. Titrated skin prick tests (SPTs) and laboratory studies were performed at regular intervals. Results: Twenty-eight subjects were enrolled in the study. Three peanut OIT subjects withdrew early in the study because of allergic side effects. During the double-blind, placebo-controlled food challenge, all remaining peanut OIT subjects (n = 16) ingested the maximum cumulative dose of 5000 mg (approximately 20 peanuts), whereas placebo subjects (n = 9) ingested a median cumulative dose of 280 mg (range, 0-1900 mg; P < .001). In contrast with the placebo group, the peanut OIT group showed reductions in SPT size (P < .001), IL-5 (P = .01), and IL-13 (P = .02) and increases in peanut-specific IgG(4) (P < .001). Peanut OIT subjects had initial increases in peanut-specific IgE (P < .01) but did not show significant change from baseline by the time of OFC. The ratio of forkhead box protein 3 (FoxP3)(hi) : FoxP3(intermediate) CD4+ CD25+ T cells increased at the time of OFC (P = .04) in peanut OIT subjects. Conclusion: These results conclusively demonstrate that peanut OIT induces desensitization and concurrent immune modulation. The current study continues and is evaluating the hypothesis that peanut OIT causes long-term immune tolerance. (J Allergy Clin Immunol 2011;127:654-60.)
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